Urology if confined to kidney; refer to UCSF if evidence of neurovascular invasion on CT
Breast disease (benign or cancer)
General surgery
Breast reconstruction or reduction
Plastic surgery. For reduction, first document 20 lb weight loss without reduction in bra size and symptoms (eg back or neck pain, intertrigo)
Thyroid or parathyroid disease
ENT or General surgery (Weiss, Miller, Gynn or Rafael, not Berguer -- per Dave MacDonald, September 2008)
Varicose vein stripping
General surgery—Dr. Weiss or Gynn or Berguer
Venous stasis ulcers
General surgery, or chart check to wound clinic for review
Lipomas
Big can go to general surgery, small to minor procedures
Diabetic foot ulcers
General surgery or podiatry
Decubitus ulcers, Stage 3 or 4
General surgery, or chart check to wound clinic if complicated
Peripheral vascular disease
Vascular surgery (NOT general). T-codes (TO etc), and A-codes such as AP (Basic Health that has applied for disability) or people who are clearly disabled and should apply for disability need to be referred to Doctors (Dr. Sharon Drager), or UCSF or Davis (whoever's on call for emergencies). CCHP pts can go to John Muir
Thoracic surgery. CCHP patients got to East By Cardiovascular and Thoracic Associates at JMMC Concord (925) 689-3100. T-codes (TO etc), and A-codes such as AP (Basic Health that has applied for disability) or people who are clearly disabled and should apply for disability need to be referred to Doctors, Highland, or UCSF or Davis (whoever's on call for emergencies).
Foreign body removal
Minor procedures if palpable, in subQ; General surgery if in deep structures of abdomen/limb; Ortho if for hardware removal; ENT or plastics if in face/neck
Both placed in OR or IR with Dr. Howard Young (Dr. Young here on Mondays only) Tunneled lines can be removed in minor procedures; Portacaths usually in OR--send to General surgery to schedule.
Hidradenitis suppurativa
General surgery
Melanoma
Plastic surgery for wide excision, sentinel node dissection. For initial diagnosis, biopsy can be done by FP, derm, minor procedure, general surgery, or ENT if on head/neck
Anal condylomata
General surgery
Staple/stitch removal
Minor procedure (nurse can do) or FPC
Facial trauma/reconstruction
ENT and/or plastics
Eyelids, orbits, facial skin lesions
ENT, plastics, and ophthalmology
Eyeball problems
Ophthalmology
Ear issues
Unless problem is clearly external (eg foreign body in canal, lesion on auricle, otitis externa after water exposure), order audiogram as well as ENT referral.
Hearing loss in elderly
Order an audiogram first. If the audiogram shows symmetric hearing loss and the audiologist does not make a specific recommendation for an ENT referral then they DO NOT need to see ENT. Any MD can fill out the MediCal hearing aid clearance forms. If they are health plan and covered for a hearing aid the audiologist can take care of it without an MD.
Proper surgery referral grid
This table was submitted by Kim Haglund, surgical registrar, September 2008. Please notify both of us of any errors noted.Mediastinal tumors
Esophageal disease, esophageal and airway stent placement